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27 Nov 2017
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Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1

COC plus spironolactone more effective than metformin for PCOS

Tristan Manalac
06 Oct 2017

In women with polycystic ovary syndrome (PCOS), combined oral contraceptive (COC) with spironolactone is more effective than metformin in reducing symptoms while showing a similar safety profile, according to a new randomized clinical trial (RCT).

“In our present RCT, the combination of COC plus spironolactone was more effective than metformin for the treatment of PCOS in terms of amelioration of clinical and biochemical hyperandrogenism and restoration of regular menstrual bleeding,” researchers said.

The researchers randomized 46 women with classic PCOS to receive either metformin (n=22; mean age 23±6 years; mean body mass index [BMI], 312.2±9.0 kg/m2) or COC plus spironolactone (n=24; mean age 25±5 years; mean BMI, 30.6±7.9 kg/m2). There were no significant differences in baseline characteristics between the treatment groups.

Compared with metformin, COC plus spironolactone produced a significant reduction in hirsutism score (mean difference [MD], 4.6 points; 95 percent CI, 2.6 to 6.7 points; p<0.0001) and total testosterone (MD, 1.1 nmol/L; 0.4 to 1.7 nmol/L; p<0.0001). [Eur J Endocrinol 2017;177:399-408]

Reductions in free testosterone (MD, 25 pmol/L; 12 to 39 pmol/L; p=0.0002), androstenedione (MD, 5.5 nmol/L; 1.8 to 9.2 nmol/L; p=0.0002) and dehydroepiadrosterone-sulphate (DHEAS; MD, 2.7 µmol/L; 1.4 to 4.0 µmol/L; p<0.0001) were also significantly greater in women who received COC plus spironolactone.

In contrast, DHEAS levels in those who took metformin increased by 35 percent.

There was also a lower frequency of menstrual dysfunction in the group who took COC plus spironolactone compared with those who took metformin (odds ratio [OR], 0.06; 0.02 to 0.23; p<0.0001).

There were no differences in the frequencies of cardiometabolic disorders such as abnormal glucose tolerance (OR, 1.7; 0.7 to 4.4; p=0.255), dyslipidaemia (OR, 0.6; 0.2 to 1.8; p=0.390) and hypertension (OR, 0.3; 0.5 to 2.0; p=0.219).

Current findings indicate that, despite the recent popularity of insulin sensitizers such as metformin, the traditional approach of using COC and antiandrogens appears to have higher efficacy and result in fewer negative side-effects, according to researchers.

COCs are thought to worsen insulin resistance and glucose tolerance which is detrimental to PCOS patients who frequently also have insulin resistance and other metabolic comorbidities, explained researchers. This contributed greatly to the increase in preference for insulin sensitizers.

“However, our present results provide evidence that when associated with lifestyle advice, COC plus spironolactone did not appear to influence negatively the metabolic milieu of PCOS, showing no overall differences with metformin on surrogate indexes of insulin resistance, lipid profiles, blood pressure and frequencies of metabolic disorders and hypertension,” said researchers.

“Hence, we suggest that COC plus spironolactone should be considered as a valid pharmacological approach for the treatment of patients with classic PCOS not seeking fertility,” they added.

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Most Read Articles
27 Nov 2017
Transdermal oestradiol added to progesterone reduces menopause-related depression, researchers reported at the annual meeting of The North American Menopause Society in Philadelphia, US.
5 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1